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Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPILICATION FOR BUILDING PERMIT
Date 3t7 19 Permit No. S y 7 2
Application is hereby made for a permit to �u rib(
a 1 story, Type � Use Zone e/-e•"6.
at 4 — Occupancy
to be occupied only as - Parking Space
in accordance with Plans, Specificat' s d Plot- an til here. Fire Sprinkler
Estimated Value of Improvem
Exemption from requirement for State of California for Contractor's Licenses hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #' 13-1 17'3f 6
is in full force and effect and properly authorizes this application.
r
San Jose City Business License # zz
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workmen's compensation laws of California.
Owner' c 143'3`65 or<. Address 117S- S'a, WT
Bf Address
99/5—W01—I-08Z wioj
4 boon+s
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NOUL dSN1 d0 480038